Systematic review and meta-analysis of family-based interventions for early psychosis: Carer and patient outcomes

Abstract

Background

Previous reviews have indicated that family interventions in early psychosis are beneficial for patients and family caregivers. Given recent developments in research and service provision an updated review is warranted.

Methods

We conducted a systematic review and meta-analysis of family intervention trials in the first 5 years after psychosis onset. We identified randomized controlled trials that reported outcomes for family members and extracted available outcomes in relation to identified patients.

Results

We screened 8737 abstracts and 177 full text papers, resulting in 36 for extraction. We found significant pooled treatment effects for family interventions for carer psychological distress (Hedges g = 0.35), carer burden (Hedges g = −0.68), positive and negative carer appraisals (Hedges g = 0.20, g = −0.21), and components of expressed emotion (critical comments and emotional overinvolement) compared with care as usual (Hedges g = −0.81, −0.92). For patients we found a moderate pooled effect for reduced rates of hospitalization compared with care as usual (Hedges g = −0.52). The effects for carer burden were maintained for studies in China, but not in other settings combined. The effects for hospitalization were maintained for multicomponent interventions but not when psychoeducation was the sole component. There was evidence of significant study heterogeneity. Risk of bias assessment indicated that deviations from intended treatment were most frequently rated as the weakest domain.

Conclusions

Family interventions for early psychosis benefit both family carers and their relatives diagnosed with psychosis when compared with usual care. Future research should further clarify the effective components and investigate innovations in cultural sensitivity, peer support and digital modes.